Common Aging Changes - Nervous System PDF

NRSG370- Gerontological Nursing- Week 10 Common Aging Changes - Nerves system LEARNING OUTCOMES At the end of the session students should be able to: Describe the effect of aging on the nervous system. List risk factors for neurologic problems in older adults Explain the health promotio...

NRSG370- Gerontological Nursing- Week 10 Common Aging Changes - Nerves system LEARNING OUTCOMES At the end of the session students should be able to: Describe the effect of aging on the nervous system. List risk factors for neurologic problems in older adults Explain the health promotion measures Explain neurological conditions -dementia, delirium & depression. Discuss interventions for addressing dementia-related behaviors, including environmental modifications and communication techniques. Develop nursing care plan for an individual with delirium and dementia related Alzheimer's disease. Effects of aging on nervous system-Brain Loss of nerve cells mass Atrophy of brain and spinal cord brain weight decreases Nerve cells: The number of nerve cells decrease (Neurons)- fewer dendrites and demyelination of the cells occurs slow nerve conduction slower response and reaction time Reflexes become weaker Factors that affect brain function: o changes in brain chemicals (neurotransmitters) o changes in nerve cells themselves o toxic substances that accumulate in the brain over time, and o inherited changes. Effects of aging on nervous system- Brain Plaques, tangles, atrophy of the brain Free radicals accumulate Decrease in cerebral blood flow Fatty deposits accumulate in blood vessels Ability to compensate declines with age Intellectual performance maintained until at least 80 years of age Age-related changes that affect nervous system - BRAIN  Impairment in Responses and reflexes- slow nerve transmission  Slowed motor skills and deficits in balance and coordination - Delay in time required to perform tasks  Some memory loss, especially short term memory loss  Sensitivity of nerve ending in skin decreases- diminished of sense touch  Decline in the function of cranial nerves - Senses of vision, smell, & taste and hearing  Verbal skills maintained until age 70 Effects of aging on nervous system Cerebral blood flow: o 20% declination – due to accumulation of fatty deposits stroke o Different aspects of brain function may be affected at different times: Short-term memory and the ability to learn new material tend to be affected relatively early. Verbal abilities - vocabulary and word usage may begin to decline later. Intellectual performance — the ability to process information (regardless of speed)—is usually maintained if no underlying neurologic or vascular disorders are present. Age-related changes that affect nervous system – Spinal Cord  Vertebral disks - hard and brittle and parts of the vertebrae may overgrow - lose its capacity to cushion - more pressure is put on the spinal cord and on the branches of the nerves that emerge from spinal nerve roots. Consequences: The increased pressure - result in decreased sensation and sometimes decreased strength and balance. Increased risk FALL Peripheral nerves o Slow conduction of impulses and release neurotransmitters is impaired - resulting in decreased sensation, slower reflexes, and clumsiness. Age-related changes that affect nervous system – Spinal Cord  Changes in the autonomic regulation- compromised thermoregulation- decreased temperature sensitivity - hypo/ hyperthermia. Reduced :  Brain catecholamine synthesis  Brain dopamine synthesis Consequences: Increased risk of sleep disorders- deep sleep decreases Delirium Neurodegenerative diseases. Age-related changes that affect nervous system – Cognition  The brains ability to process, retain, and use information Including: Reasoning, judgement, perception, attention, comprehension and memory Cognitive Disorder:  Is disruption or impairment in the higher level functions of the brain  Affects functions of daily life  Can cause people to forget the names, to be unable to perform daily tasks, and neglect personal hygiene. Neurologic Health Promotion Many neurologic disorders occur for reasons beyond a person’s control Risk factors - smoking, obesity, stress High cholesterol, HTN Risk of injury To head & Spinal column increased due to unsafe actions- Failure to use seat belts, incompetent driving skills, alcohol & drug abuse & Falls Infections can leads to neurological dysfunction. Preventive measures for neurologic health Nurses can detect new or subtle symptoms of neurologic disorders Subtle Indications of Neurologic Problems New headaches that occur in the early morning or interrupt sleep Change in vision (e.g., sudden decreased acuity, double vision, and blindness in portion of visual field) Sudden deafness, ringing in ears Mood, personality changes Altered cognition or level of consciousness Clumsiness, unsteady gait Numbness, tingling of extremity Unusual sensation or pain over nerve Age-related changes that affect nervous system – Selected Neurological conditions Negative functional Consequences: Common disorders:  Depression  Stroke  Hypothyroidism  Alzheimer disease Note: - Physical exercise may slow the age-related decline in brain function. - Having uncontrolled high blood pressure, diabetes, or high cholesterol levels can speed the age-related decline in brain function. Selected Neurological conditions - Cognitive impairment and Older persons. Cognitive impairment – disturbance in cognitive functioning – memory, orientation, attention, concentration, judgement, learning ability, perception, problem solving, psychomotor activity, reaction time and social ability. Common causes in older adults are- degenerative process of the CNS  Parkinson's disease (PD), Alzheimer's disease (AD)and CVA.  Three D’s of Cognitive impairment. Delirium Dementia Depression Note: these are not a normal consequences of aging, but the incidence increases as one grows older. Selected Neurological conditions -- Delirium A syndrome that involves a disturbance of consciousness accompanied by a change in cognition.- serious change in the mental abilities Develops over a short period, fluctuates or changes through out the course of the day.  10-15% in hospital & with general medications are delirious at any given time. 30-50% of acutely ill older clients at some time during their stay at hospital Risk factors:  Severity of the physical illness  Older age  Baseline cognitive impairment  Medications - anticholinergics and any new medications Selected Neurological conditions -- Delirium  Risk factors contd… Invasive equipment - IV lines. Catheters, NG tube, restraints Sleep deprivation Immobility Visual/ hearing impairments  SYMPTOMS  Difficulty in pay attention  Easily distracted and disoriented  Sensory disturbances- illusions, misinterpretations/ hallucinations  Can have sleep –wake cycle disturbances  Changes in the psychomotor activity  May experience anxiety, fear, irritability, euphoria or apathy Selected Neurological conditions -- Delirium Treatment: Identify and treat the causal or contributing medical conditions. Medications: Antipsychotics: - Haloperidol (Haldol) – to decrease agitation Adequate hydration and food intake Iv fluids/ TPN Physical restraints when necessary Selected Neurological conditions -- Delirium Nursing Interventions: Optimal management of all medical conditions Pain management Early and aggressive ambulation Safety - Prevention of fall Prevention of aspiration for those at risk Provision of aids to orient with correct information- clock, calendar, white board Frequent verbal orientation and explanation of current activities Maintain a good bowel and urinary function Meet the physiologic and psychologic needs Behaviour, mood and level of consciousness of these clients can fluctuate rapidly through out the day Family caregiver support and presence Environmental support- noise reduction, maintenance of normal day, place a dim light at night, access for familiar objects/person Selected Neurological conditions - Dementia  A syndrome or group of progressive neurological disorders - a gradual decline in cognitive function and memory. Memory- Forgetfulness- progressive Understanding - Difficulty in doing familiar tasks, Confusion Judgement - poor Decline in intellectual functioning decision making, communication. A substantial cause of morbidity in any ageing population Affects 10% OF INDIVIDUALS OVER 65 and 20% over 80 years. Note: dementia is not a part of normal aging medical conditions, substance use, or medication effects. It has a slow, insidious onset, and is chronic, progressive, and irreversible. Dementia: Diagnostic criteria Memory impairment- impaired ability to learn new information or to recall old information or previously learned information. Include at least one or more of the following: Aphasia- deterioration of language function -A speech disorder resulting in difficulties producing or comprehending speech. Apraxia - inability to carry out motor functions despite intact memory abilities Agnosia: Inability to recognize or name objects, person, sounds, shape or smell despite intact sensory abilities. Disturbance in executive functioning – ability to think abstractly and to plan, initiate, sequence monitor and stop complex behaviour Dementia: Diagnostic criteria Aphasia  Inability to name the familiar objects or people and then progress to speech that becomes vague or empty with excessive use of terms such as ‘it’ or ‘thing’  May exhibit : Echolalia: echoing what is heard o Pallilaia: repeating words or sounds over and over Apraxia: o Loss of ability to perform routine self-care activities such as dressing or cooking. Agnosia: May be frustrating for clients Disturbance in executive functioning- inability to learn new material, solve problems or carry out daily activities DEMENTIA - Types of Dementia: Primary Progressive Dementia  Alzeimer’s disease (AD) - Reduction in brain acetylcholine, the formation of plaques and tangles, serious head trauma, and genetic factors.  Secondary Dementia  Parkinson’s disease -caused by a loss of nerve cells in the substantia nigra of the basal ganglia - closely resemble those of AD.  Alcohol assisted dementia  Post stroke dementia Types of Dementia - Alzheimer's disease An irreversible, progressive brain disease that slowly destroys memory and thinking skills, and eventually the ability to carry out the simplest tasks, including:  Loss of speech  Loss of motor function  Profound personality and behavioural changes - paranoia Delusions / Hallucinations Inattention to hygiene and belligerence In most people with Alzheimer’s, symptoms first appear after age 60. It’s the 5th leading cause of death for adults over 65. Most patients typically start showing signs and symptoms of this disease after the age of 60. More likely to develop in WOMEN Types of Dementia - Alzheimer's disease  Etiology:  Atrophy of the cerebral neurons  Senile plaque (of beta-amyloid ) deposits in between neurons  Neurofibrillary tangles within the neuron  Enlargement of the 3rd and 4th ventricle of the brain Risk increases with age: Average duration from onset of symptoms to death is 8-10 years Alzheimer's with late onset- after 65 years of age may have genetic component Alzheimer's disease Alzheimer's disease- Signs and Symptoms There are four stages, with progressive patterns of cognitive and functional impairments.  Stage 1 - Pre-dementia o The client is aware that something is happening to them and may become overwhelmed and frightened. Characterized by: recent memory loss increased irritability impaired judgment loss of interest in life decline of problem-solving ability reduction in abstract thinking. o Providing emotional support and individual counselling Alzheimer's disease- Signs and Symptoms Stage 2 - Early lasts 2 to 4 years Decline in the patient’s ability to: manage personal and business affairs an inability to remember shapes of objects continued repetition of a meaningless word or phrase (perseveration) wandering or circular speech patterns (circumlocution dysphasia) wandering at night Restlessness Depression anxiety, and intensification of cognitive and emotional changes of stage 1. Educate - Progression of the disease, Future planning and medications Alzheimer's disease- Signs and Symptoms  Stage 3 - Moderate: Characterized by: impaired ability to speak (aphasia) inability to recognize familiar objects (agnosia) inability to use objects properly (apraxia) inattention, distractibility involuntary emotional outbursts urinary or fecal incontinence lint-picking motion, and chewing movements. Progression through stages 2 and 3 varies from 2 to 12 years.  Safety is a priority consideration as the client’s cognitive ability deteriorates. Types of Dementia - Alzheimer's disease- Signs and Symptoms  Stage 4- advanced: Interventions: which lasts approximately 1 year. Use touch when appropriate Characterized By: a masklike facial expression Incorporate no communication nonverbal communication Apathy Withdrawal, eventual immobility Have music and assumed fetal position imagery available no appetite, and emaciation. during the day Alzheimer's disease - Diagnostic Examination History- collateral history from relatives o Physical examination - presence of characteristic neurological and neuropsychological features. o CT, MRI, SPECT or PET - to help exclude other cerebral pathology or subtypes of dementia. o Assessment of intellectual functioning - memory testing - characterize the state of the disease  Dementia - Alzheimer's Disease Medical Management: The initial management: - education of the family and caregivers regarding the disease, the prognosis, and changes in lifestyle that are necessary as the disease progresses.  Dementia - Alzheimer's Disease Nursing Diagnosis:  Self-care deficit r/t impaired cognitive and motor function Risk for Injury or trauma / fall r/t disorientation, confusion, impaired decision making / cognitive impairment Caregiver Role Strain r/t continuous need for providing care  Chronic confusion r/t alteration in structure / function of bran tissue. Goal: The client will accept explanations of inaccurate interpretations within the environment. With assistance from the caregiver, the client will be able to interrupt non- reality-based thinking. Alzheimer’s Disease - Nursing Interventions - improve safety & Functioning in people with dementia  Environmental modifications: Use clocks , calendars, daily news paper and simple written cues for orientation. (E.g., Day , date, names, place and events) Use simple pictures written cues, colour codes for identifying items and places (Toilet, bedroom) Use simple cues to clarify directions for operating radios, TV, appliances…etc have safety bars installed in the bathroom and have 24 hour alarms on the doors. Alzheimer’s Disease - Nursing Interventions - improve safety & Functioning in people with dementia Environmental modifications contd… Place pictures of familiar people in highly visible places, use nonglossy papers& non glare glass in picture frame. Turn lights on as soon as or before gets dark Use night lights or dim lights during the night Provide adequate environmental stimuli but avoid overstimulation - Reduce environmental stimuli to redirect the client’s attention – to reduce emotional lability Alzheimer’s Disease - Nursing Interventions - improve safety & Functioning in people with dementia  Ensure safety: Carry some form of identification along with phone number of someone to call Use alarm devices to prevent wandering Label cabinet, doors…etc Lock doors at night Keep the environment uncluttered Keep medications and other harmful solutions in inaccessible places  Alzheimer’s Disease - Nursing Interventions - improve safety & Functioning in people with dementia  Independent performance of ADL: Keep all activities as simple and routine as possible Arrange the clothing in the order in which the items are to be donned. Leave the tooth brush in the bathroom with toothpaste already on it. Administer ordered medications and note their effects. If the patient has trouble swallowing, crush tablets and open capsules and mix them with a semi soft food Alzheimer’s Disease - Nursing Interventions - improve safety & Functioning in people with dementia Independent performance of ADL: Provide rest periods between activities because the patient tires easily. Encourage the patient to exercise as ordered to help maintain mobility. Encourage patient independence and allow ample time for him to perform tasks. Take the patient to the bathroom at least every 2 hours and make sure he knows the location of the bathroom. Assist the patient with hygiene and dressing as necessary. Frequently check the patient’s vital signs. Alzheimer’s Disease - Nursing Interventions - Nutrition  Provide finger foods and nutritious snacks if the client can not sit and eat at table.  Serving soup in a mug  To encourage adequate nutritional intake- stay with the client and encourage to eat.  Encourage sufficient fluid intake and adequate nutrition. Alzheimer’s Disease - Nursing Interventions - Verbal communication Establish an effective communication system with the patient and his family to help them adjust to the patient’s altered cognitive abilities. Simplify sentences according to the persons ability to process information use close-ended questions - Repeating the question aids comprehension If not able to understand the statement, repeat with the same statement using the same word Present only one idea at a time, in short sentences, Allow enough time for processing; Use positive statements Avoid baby talk or use of demeaning; Avoid sarcastic humour Alzheimer’s Disease - Nursing Interventions - Verbal communication Assist with missing words repeat the persons sentence with correct word. Paraphrase what person says and ask for clarification Do not argue with the client, unless it’s a matter of safety Involve the person with decisions to the best of his / her ability by offering simple, concrete choices avoid questions that require the client to make choices Do not ask questions that you know the person cannot answer correctly Provide emotional support to the patient and his family. Do not test the persons memory unnecessarily Avoid shaming the person Alzheimer’s Disease - Nursing Interventions -non verbal communication Attract and maintain the persons attention – eye contact, pleasant facial expressions Use relaxed and smiling approach Reinforce verbal communication with appropriate non verbal communication -( Demonstrate) Use simple pictures rather than written cues Use appropriate touch for communication, unless the client respond negatively to touch Closely observe all the non verbal cues exhibited by the person particularly that express feelings. Remain calm and talk quietly to the client – when agitated and combative Reference: Elipoulos, C., 2017. Gerontological Nursing. 9th ed. New York: Wolters Kluwer Medical. Touhy, T., 2019. Ebersole & Hess' Toward Healthy Aging. 10th Ed. [S.L.]: Mosby Miller,C.A,. 2019. Nursing for wellness in Older adults. 8th ed. New York: Wolters Kluwer Medical.